Management of recurrent rectal cancer: a population based study in greater Amsterdam.
OBJECTIVE
To analyze, retrospectively in a population-based study, the management and survival of patients with recurrent rectal cancer initially treated with a macroscopically radical resection obtained with total mesorectal excision (TME).


METHODS
All rectal carcinomas diagnosed during 1998 to 2000 and initially treated with a macroscopically radical resection (632 patients) were selected from the Amsterdam Cancer Registry. For patients with recurrent disease, information on treatment of the recurrence was collected from the medical records.


RESULTS
Local recurrence with or without clinically apparent distant dissemination occurred in 62 patients (10%). Thirty-two patients had an isolated local recurrence. Ten of these 32 patients (31%) underwent radical re-resection and experienced the highest survival (three quarters survived for at least 3 years). Eight patients (25%) underwent non-radical surgery (median survival 24 mo), seven patients (22%) were treated with radio- and/or chemotherapy without surgery (median survival 15 mo) and seven patients (22%) only received best supportive care (median survival 5 mo). Distant dissemination occurred in 124 patients (20%) of whom 30 patients also had a local recurrence. The majority (54%) of these patients were treated with radio- and/or chemotherapy without surgery (median survival 15 mo). Twenty-seven percent of these patients only received best supportive care (median survival 6 mo), while 16% underwent surgery for their recurrence. Survival was best in the latter group (median survival 32 mo).


CONCLUSIONS
Although treatment options and survival are limited in case of recurrent rectal cancer after radical local resection obtained with TME, patients can benefit from additional treatment, especially if a radical resection is feasible.
Bakx
Roel
R
Academic Medical Center, Department of Surgery, Meibergdreef 9, G4-137, Amsterdam AZ 1105, Netherlands. r.bakx@amc.uva.nl
Visser
Otto
O
Josso
Judith
J
Meijer
Sybren
S
Slors
J-Frederik-M
JF
van Lanschot
J-Jan-B
JJ
D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000628:therapy*; D009426:Netherlands; D011379:Prognosis; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000628:therapy*; D012007:Rectum / Q000601:surgery; D012042:Registries; D012189:Retrospective Studies